Dear Bill | Relapse Reactivation Failure

Posted by Bill Esteb on Jan 4th 2020

Dear Bill

I have patients who suffer a relapse and return to my office mentioning that they stopped care because they felt better. While I'm delighted they came back, I can't help but feel that I failed. Do they care about spinal decay? Do they care about nerve function? Or, are most people just operating on a basic survival mode?

First of all, congratulations on having a practice in which patients feel safe returning for more care. Far too many chiropractors make discontinuing care so shameful that it often prevents them from returning.

I think there are several issues in play here.

Once You Go...

Virtually every new patient has heard that once you go to a chiropractor, you have to go for the rest of your life. So the intrepid souls who make that initial appointment have their shields up and  phasers on stun. Their intent is to get the relief chiropractic promises, without succumbing to any overture to continue their care beyond symptomatic relief.

Overcoming this is difficult, maybe impossible. However, you might want to try. The way to do it is NOT to make a rational case for the value of ongoing supportive care. You've already tried that.

Instead, during the initial consultation or report of findings you might ask, "Have you heard that once you go to a chiropractor you have to go for the rest of your life? Most of our new patients have. The good news is you don't have to do anything. How long you benefit from chiropractic care is always up to you. It's your body, your health and your future. We're here to serve and help you get what you want."

If you actually believe that (which is helpful), watch their body language and you'll notice a softening of their face and a relaxation of their posture.

"When you've had enough, let me know. We'll close your case file properly, celebrate your success and send you on your way. And later, if your problem should return, and these sorts of problems often do, come on back. Your records will be here along with our genuine concern for you and your health."

Make the words your own. However, the key element here is to communicate your desire to help; that you're not emotionally attached to their choice and to foreshadow the possibility of a relapse. All, while revealing that there's no shame in returning for care.

Learning Through Failure

The second factor in play here is the way we learn. The most effective teacher is good old-fashioned failure. And in this situation let's define failure as a patient who has been told the truth, chooses to use chiropractic as a short-term treatment, discontinues care and then later, suffers a relapse.

The key is to make sure they don't blame chiropractic ("I tried chiropractic but it didn't work," meaning it wasn't a permanent solution) or blame you ("I went to Dr. X over 20 times but he didn't fix me.")

You might want to foreshadow the possibility of a relapse by observing something like, "The retraining and strengthening of muscles and ligaments supporting your spine happen after the relief of obvious symptoms. Yet, many of our patients choose to discontinue their care as soon as they feel better. So naturally, their problem returns—usually at some moment of stress months later. Should that happen, please don't blame me and please don't blame chiropractic. Just give us a ring and we'll start over. No problem."

Expressing your neutrality and comfort with them stopping care prematurely sounds counter-intuitive, but it enhances the likelihood of their return. After all, you'd want them returning to your practice rather than trying a different chiropractor down the street or giving up on chiropractic altogether.

This is especially true with a chiropractic virgin. They see their spinal owie as something akin to an infection, a cut or the common cold with a beginning, middle and end. Instead, due to long-term neglect, the scar tissue and habituation causes many patients to have a problem that can never be fully "fixed" and will require some type of ongoing supportive care for the rest of their lives. But they don't believe you. Tell them anyway. Just don't expect a first timer to actually act on your recommendations.

The reason to deploy this long-term strategy is because of way we learn. Which you can test for yourself. Take an inventory of your reliable once-a-monthers and you'll discover that before they embraced chiropractic on a regular basis, they repeatedly stopped and started care with either you or some other chiropractor before they got the big idea.

Or, as a woman in a patient focus group I conducted in Stamford, Connecticut observed after confessing that she had started and stopped her care three times, "It occurred to me that maybe if I kept coming in on some type of regular basis my headaches wouldn't keep coming back."

It took her almost three years to figure this out. Some may never figure it out and that's okay too.

Each Patient's Priorities

The third issue in play here is the different value that each of us places on our health.

You and I, because we have chosen careers in health care, place a relatively high value on our health. It's probably amongst our top ten values.

If good health, longevity and quality of life is further down on a patient's list of priorities, regardless of what they promise you at the outset of their care, they will drop out once the cessation of symptoms permits them to get back to their higher priorities.

Patients will often justify their decision by claiming that they can no longer "afford to keep coming in." That's code for: I have other priorities.

Being angry or even visibly disappointed is fruitless. Because there is NOTHING you can say or do to change the hard wiring of their values. Not even the most compelling report of findings. Instead, it takes a near death experience, divorce or retirement to prompt a rethink of their values. And maybe not even then.

So relax. Slow down. Play the long game.

The belief that there is some special script or office procedure that can "seal in a patient for life" is as unreal as the   philosopher's stone, the Fountain of Youth or the lost city of gold. Sadly, it has been used to seduce chiropractors into signing up for expensive coaching or feelings of less-than when they are unable to impose their well-intentioned recommendations onto patients who instead, routinely express their free will agency.

100% Perfect Compliance

Consider this. What if you were able to produce 100% compliance? What if patients did everything you told them to do? I suspect that heady feeling would be interesting for only about a week or two. Soon you'd feel like a neuro-mechanical robot.


Thus, one could make a case that a sense of fulfillment and personal satisfaction come from the process of seeing incremental progress over the course of perhaps years. Plus, the creativity of learning new, more effective ways of communicating the truth in a compelling and persuasive manner. This is what produces joy, purpose and value. It's the "dance" that makes it interesting and soul satisfying.

At least that's my theory. What's yours?

Thanks for the question!

Email Bill with your question.

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